Starting your Old Mutual - International

Customer ID number(s) If known please enter the Customer ID number(s) Starting your Old Mutual International - International Portfolio Bond (Old Mutual International Trust Company Loan Trust Application Form) For UK clients only Applicant 1 Applicant 2 Financial adviser details Old Mutual International account number Name of financial adviser Company name Address Telephone number Fax number E-mail address Old Mutual International only accepts business introduced by companies which have Terms of Business with us. January 2018 This document was last updated in January 2018. Please confirm with your financial adviser that this is the most up-to-date document for your product or servicing needs We only sell our products through financial advisers as we believe it is important you receive independent financial advice. As it is you who chooses your financial adviser, you need to bear in mind that they are acting on your behalf and not on behalf of Old Mutual International or Old Mutual International Trust Company. You are responsible for their actions or omissions. TAXATION INFORMATION Under Automatic Exchange of Information (AEOI) regulations Old Mutual International is required to obtain information about an applicant s tax status. To enable us to comply with these regulations, when submitting this application form you must also submit the Taxation information and self-certification for entity investors. Completion and submission of a self-certification is mandatory and failure to provide one could result in your Portfolio being reported under AEOI by default. If any of the information contained in the self-certification changes please advise Old Mutual International promptly so we can determine if a new self-certification is required. Important information This application form is completed by you, the Settlor(s), for consideration by Old Mutual International Trust Company as the trustee for the Loan Trust you have created. Old Mutual International Trust Company has complete discretion over where the trust monies are invested. This form will only be a valid application to Old Mutual International for an Old Mutual International - International Portfolio Bond Life, or Old Mutual International - International Portfolio Bond Redemption, if Old Mutual International Trust Company signs and seals section J. The investment will not be made into the Bond until such time as Old Mutual International Trust Company submits this application form to Old Mutual International. Please note that Old Mutual International Trust Company is a non-uk resident trust company and therefore is not entitled to cancellation rights in respect of an Old Mutual International Bond. Before completing this application please make sure you have read the product literature: Key features of your Old Mutual International - International Portfolio Bond Details of your Old Mutual International - International Portfolio Bond Redemption (ref IPBRv2) or Details of your Old Mutual International - International Portfolio Bond Life (ref IPBv2) Policy Terms Unlocking the secrets of intelligent investing product brochure. Explaining your Portfolio Bond fees and charges The International Portfolio Bond Redemption at a glance or The International Portfolio Bond Life at a glance Your financial adviser will be able to provide you with the relevant product literature. Completing the form To complete this form: use CAPITAL LETTERS only use blue or black ink tick boxes as appropriate complete all relevant sections; see checklist on page 15 for further details do not use correction fluid; any amendments should be crossed out and initialled by all applicants. Please note that we must receive your application form by post or courier. We are unable to accept faxed or e-mailed versions and the applications received in this way will not be processed. Please ensure that you complete all relevant sections. We will contact you regarding any missing information which will need to be provided to us in writing, and this may delay your application. Page 1 of 15

a Type of application Type of Bond Please indicate which type of Bond you are applying for: (3) The type of bond cannot be changed after it has been set up. Life assurance Capital redemption This is called the International Portfolio Bond Life. This is called the International Portfolio Bond Redemption. B Details of Trust and Settlor(s) Trust title Please advise what name you want to call the Trust e.g. the Mary Brown Policy Trust dated 1 April 1990, The John Brown Will Trust Details of the Settlor(s) In this section, please give details of the Settlor(s). The Settlor(s) must be at least 18 years old and the maximum age is 89. The maximum age for a life assured is also 89. If there are any further Settlors, please photocopy this page, attach the details with this application form and tick here (3) u If additional pages are added, each separate page must be initialled and dated by all Settlors. Settlor 1 settlor 2 Title (3) Mr Mrs Miss Mr Mrs Miss Full forename(s) Surname Previous name or alias Sex (3) Male Female Male Female Date of birth Occupation (If you have retired or do not have an occupation, please include your previous occupation) Nationality Dual nationality (if applicable) Passport number/national identity card number Residential address (Please note we do not accept c/o and PO addresses) of residence continued Page 2 of 15

b Details of all individual applicant(s) (continued) applicant 1 applicant 2 (if any) Correspondence address Telephone number including area code (daytime) Telephone number including area code (evening) E-mail address Old Mutual International accepts no responsibility for the consequences of sending documentation to this correspondence address, or to an address notified subsequently. Old Mutual International reserves the right to send correspondence to the residential address where regulations prevent it being sent to any other alternative address. Is the Settlor(s) also going to be a life assured? (3) Yes No Yes No u You only need to complete this if you have selected life assurance, ie the International Portfolio Bond Life, in section A. Reason for investment (for example, inheritance tax planning) C Corporate Trustee applicant Details of Corporate Trustee applicant Name of corporate trustee Address (address of the registered office) Old Mutual International Trust Company Limited PO Box 142 King Edward Bay House, King Edward Road Onchan, Isle of Man IM99 3DJ Isle of Man Telephone number 01624 655456 Page 3 of 15

D Details of lives assured You only need to complete this section if you have selected life assurance, ie the International Portfolio Bond Life, in section A. The maximum age for a life assured is 89. First or sole life assured Title (3) Mr Mrs Miss Full forename(s) Surname Full residential address (Please note we do not accept c/o or PO Box addresses.) Date of birth Sex (3) Male Female Nationality (Please include any dual nationality) Occupation (Please include previous occupation if retired) Joint life assured (if any) Title (3) Mr Mrs Miss Full forename(s) Surname Full residential address (Please note we do not accept c/o or PO Box addresses.) Date of birth Sex (3) Male Female Nationality (Please include any dual nationality) Occupation (Please include previous occupation if retired) Page 4 of 15 continued

D Details of lives assured (continued) Further life assured (if any) Title (3) Mr Mrs Miss Full forename(s) Surname Full residential address (Please note we do not accept c/o or PO Box addresses.) Date of birth Nationality (Please include any dual nationality) Sex (3) Male Female Occupation (Please include previous occupation if retired) Further life assured (if any) Title (3) Mr Mrs Miss Full forename(s) Surname Full residential address (Please note we do not accept c/o or PO Box addresses.) Date of birth Nationality (Please include any dual nationality) Sex (3) Male Female Occupation (Please include previous occupation if retired) If there are further lives assured, please provide the details as above on a separate sheet and tick here. (3) continued Page 5 of 15

E Charges and policy denomination Old Mutual International s charges Please enter the code for the Old Mutual International charge package that your financial adviser has explained will apply to your International Portfolio Bond Policy currency I wish the Bond Policies to be denominated in (currency) Note: The Policy currency can not be changed after the Policy is set up. If no currency is indicated your Bond will be denominated in Sterling. For a list of currencies in which you can denominate your Bond, please see the client agreement, if you have not received a copy please ask your financial adviser. Currency conversions If you denominate the Bond in a currency other than that in which the premium is paid, you should be aware that a notional currency conversion will be required which could expose you to exchange rate fluctuations. Any conversion will be at the mid-market rate, as determined by Old Mutual International, on the date that Old Mutual International receives credit of the premium to its relevant bank account. The notionally converted amount will be the amount that is shown in the Policy Schedules. Where additional currency conversions are required as a result of transactions within the Bond, you should bear in mind that delays may occur. Please refer to the Policy Terms for any charges that may apply. F Investment details Loan amount to be invested Minimum 25,000 (or currency equivalent of 25,000) (Please state currency) Number of policies (12 policies will be allocated if left blank. This cannot be changed after the Bond is established.) Note: Minimum investment per policy is 400 (or currency equivalent of 400), where more than 12 policies are required. Page 6 of 15

G Source of funding and origin of wealth THIS SECTION MUST BE COMPLETED IN ALL INSTANCES, PLEASE NOTE THIS SECTION CONTINUES ON THE FOLLOWING TWO PAGES. Source of funds u The bank account must be in the name of the Settlor(s). Loan amount Payment currency Bank account holder (name as stated on bank account) Bank account number/ IBAN Sort code(if applicable) SWIFT or BIC code (if applicable) Bank name Bank address How long have you held this account? years months Additional information that may be required by the bank Accounts within the UK, Jersey, Guernsey, Isle of Man or Gibraltar require a bank account number and sort code. Premium payments made from banks outside the UK require a SWIFT or Bank Identifier Code (BIC), and an International bank account number (IBAN). Employer details THIS SECTION MUST BE COMPLETED IN ALL INSTANCES. Please give details of your employer or your own company, if self-employed. If you have retired or are not currently employed please include details of your previous employer or your own company. If you have never been employed, please state N/A. Please also enter your final year s salary/income and bonus if any. Settlor 1 settlor 2 (if any) Employment status (3) Employed Self Employed Employed Self Employed Retired not employed Retired not employed Date of retirement / unemployment Name of employer or your own company Address of employer or your own company Website address of employer or your own company (if any) Occupation Last year s gross salary/ income amount Currency (3) Last year s bonus amount (if applicable) Currency (3) (state currency) (state currency) US$ US$ (state currency) (state currency) US$ US$ If you receive income from another source eg dividends, interest; please provide details here continued Page 7 of 15

G Source of funding and origin of wealth (continued) Full details of origin of wealth PLEASE TICK THE DESCRIPTION OPTION(S) RELATING TO THE ORIGINAL SOURCE OF THE PREMIUM FOR YOUR POLICY. YOU MUST FULLY COMPLETE EACH RELEVANT SECTION RELATING TO THE DESCRIPTION OPTION(S) YOU HAVE TICKED. THIS SECTION MUST BE COMPLETED IN ALL INSTANCES (3) description Details required Your details Sale of shares Maturing investments Policy claim Replacement policy Name of company that held your shares/investment/policy (ie bank, stockbroker or insurance company) Name of person who held the shares/ investment policy How were they sold? (ie bank, stockbroker or other agent, if applicable) Description of shares sold (if applicable) Reason for policy claim or replacement policy (if applicable) Total amount paid out Currency: Amount: Surrender penalty incurred (if any) Date received Length of time the shares/investment/ policy held Sale of property Address of property sold (including postcode if applicable) Total sale amount Currency: Amount: Date of sale Page 8 of 15 continued

G Source of funding and origin of wealth (continued) Full details of origin of wealth PLEASE TICK THE DESCRIPTION OPTION(S) RELATING TO THE ORIGINAL SOURCE OF THE PREMIUM FOR YOUR POLICY. YOU MUST FULLY COMPLETE EACH RELEVANT SECTION RELATING TO THE DESCRIPTION OPTION(S) YOU HAVE TICKED. (3) description Details required Your details unearned income Sale of interest in company Inheritance Loan Gift Compensation Competition or gambling win Origin of wealth (if ticked ) From which organisation or whom (state the relationship if applicable) Details, including reasons where applicable (how the money was acquired etc) and for each of the description options shown below the specific information requested. Inheritance: Donor s name, relationship to donor, date of donor s death. Sale of interest in company: Name of company, nature of business, total sale amount, amount you received from the sale. Loan: Name of loan provider, address of loan provider, reason for loan. Gift: Description of gift, reason for gift. Compensation: Reason for compensation. Competition or gambling win: How was the money acquired. Total amount Currency: Amount: Date received Please enter what documentary evidence you are enclosing with this application form (if applicable). Page 9 of 15

H Asset choice Please use this section to list the assets you wish to invest in. u Please note that you can invest in as many assets as you wish, subject to a minimum of 400 (or currency equivalent) in each holding. Some asset providers may have a higher minimum investment requirement and this minimum will prevail. PLEASE NOTE IF WE DO NOT RECEIVE SUFFICIENT DETAILS, THIS WILL DELAY YOUR INVESTMENT. Appointment of a fund adviser, authorised custodian or discretionary asset manager Appointment of a fund adviser, authorised custodian or discretionary asset manager? (3) Fund adviser Authorised custodian Discretionary asset manager u Please note that if you are appointing a custodian you do not need to complete the asset choice section below. u Please note your premium must be remitted to Old Mutual International Trust Company. If you have ticked one or more of the appointment options above, you need to complete the relevant form(s); which are available from your financial adviser. Please enter which form(s) you are enclosing with this application form. (3) Appointing a fund adviser to your Old Mutual International - International Portfolio Bond or Old Mutual International Ireland European Portfolio Bond Request to Old Mutual International or Old Mutual International Ireland to appoint authorised custodian(s) Request for Old Mutual International Isle of Man Limited ( Old Mutual International ) to appoint a discretionary asset manager Asset Choice Asset identifier ISIN Asset name please enter names in full Accumulation/ Income unit requirement (if applicable) Share class (if applicable for A, B or C) Base currency of security/fund (e.g., GBP, USD) Investment % (whole % numbers only) This must meet our minimum dealing size) TOTAL (must add up to 100%) (Please continue on a separate copy of this page, which you should sign and attach to this application, if necessary.) In case we need to clarify the asset choice details above, please provide us with a contact name and telephone number. Contact name Telephone number including area code (daytime) Fax number Telephone number including area code (evening) E-mail address Page 10 of 15 continued

H Asset choice (continued) All investments required, other than Old Mutual International funds, shall be recognised by Old Mutual International or specifically agreed by Old Mutual International as eligible to be purchased by the Bond. any assets purchased in respect of the Bond will be purchased at the open market buying price as shown on the contract note used by the vendor. any third party charges relating to the purchasing of assets, such as bank charges, will be debited from your Bond. all assets are held in the name of Old Mutual International and all dealing and contract notes must be made and rendered in the name of Old Mutual International. In the absence of complete investment instructions, or if a selected fund is not available, Old Mutual International reserves the right to hold part or all of the premium in the Transaction Account. Please note that money held in the Transaction Account does not earn interest. Future deals should be submitted using the Dealing Instruction Form and faxed to +44(0)1624 615535. Please ask your financial adviser for a copy. Page 11 of 15

I Optional regular loan repayments to the Settlor(s) You will need to complete this section if regular loan repayments are required from the Bond. Please note that we will only pay loan repayments to the Settlor(s). Amount of investment to be withdrawn each year Currency (3) US$ (state currency) Percentage of initial investment to be withdrawn each year % Withdrawals frequency (3) Monthly Quarterly Half-yearly Yearly Date of first payment Notes: 1. Monthly loan repayments are only available for invested amounts totalling more than 100,000 (or currency equivalent of 100,000). 2. Minimum loan repayment amount is 500 (or currency equivalent of 500). 3. We would suggest that you contact your financial adviser before requesting that loan repayments are set up to discuss the tax implications of these encashments in the country in which you reside. 4. Where the encashment value of the units allocated to the Bond at the date of the loan repayment falls below the higher of 25% of the amount invested or 10,000 (or currency equivalent of 10,000), we may decline the repayment. Nominated Asset(s) Please state which asset(s) listed in Section H is/are to be used as the Nominated Asset(s) to pay regular loan repayments. u If there are any further nominated assets, please photocopy this page, attach the details with this application form and tick here ISIN ISIN ISIN ISIN ISIN Name Name Name Name Name Payee details For joint Settlors, loan repayments will be made to both Lenders, either in full to a joint bank account or split equally to bank accounts in each of the Settlors names. Please tick this box and attach a second Settlor s bank details, if applicable. (3) Until further notice, I/we require these loan repayments to be made to: Bank name Bank address (for payments) Account in name of Bank account number/iban Sort code - Note: We will only pay withdrawals to the Lender(s). Signature of first or sole Settlor Signature of second Settlor (if any) Date Date Page 12 of 15

J Declaration by the Settlor(s) IMPORTANT INFORMATION this section must be completed. Any omission or misstatement of a material fact in this application could affect the payment of benefits under the International Portfolio Bond Life/International Portfolio Bond Redemption. A material fact is one which is likely to influence the assessment and acceptance of the application. If you are uncertain whether a fact is material, you should give full details so that Old Mutual International can assess its possible significance. If you become aware of such a fact while Old Mutual International is considering the application, you should notify Old Mutual International immediately. Please state the country in which this application form was completed. 1. i/we have read and understand the terms and conditions detailed in this application which apply to me/us, the trustee and my/our financial adviser. 2. i/we confirm that each life assured (or parent where parental consent is required) consents to this application and agrees to my/our acting as their agent for the purpose of the information provided on this application. 3. i/we declare that to the best of my/our knowledge and belief the statements made in this application and any related documents are true and complete and that I/we have not concealed any material fact. 4. i/we understand that, while the investment decisions for the Loan Trust are made purely at the trustee s discretion by Old Mutual International Trust Company Limited signing and dating this application they are applying to enter into a contract for an International Portfolio Bond Life/International Portfolio Bond Redemption using the details I/we have completed in this application form and details I/we have completed in the Client Agreement sent to Old Mutual International Trust Company Limited. 5. i/we understand and agree that the contract that Old Mutual International Trust Company are applying to enter into with Old Mutual International will be subject to Isle of Man law and that the Policy Terms will be in the English language. 6. i/we request that the Lump Sum referred to as a Premium is invested as we have instructed as an initial premium for policies comprising either an Old Mutual International - International Portfolio Bond Life (ref IPBv2) or an Old Mutual International - International Portfolio Bond Redemption (ref IPBRv2), and we request Old Mutual International to issue the policies in the name of the trust. 7. i/we understand that in cases where the asset(s) selected in this application, if Old Mutual International Trust Company agrees to this application, is/are not redeemable for a certain period of time, Old Mutual International may not be able to return that part of the payment to Old Mutual International Trust Company until the end of that period. The description of the assets chosen will give details if this applies. We may request that Old Mutual International Trust Company consider investing immediately into non-daily dealing assets with the understanding that in the event of cancellation or requiring early access that: (a) Old Mutual International Trust Company may not get the money back immediately and payment may be delayed for some time; (b) the institution may impose penalties and therefore Old Mutual International Trust Company may get back less than it invested, and/or (c) the only way in which to receive value may be through a transfer of ownership of that asset into the name of the relevant Beneficiary or Settlor. 8. the premium detailed in this application and any other premium tendered in respect of this application are derived solely from the source of funding provided and have, where required, been declared to the relevant tax authority in my country of residence for taxation 9. the application for an Old Mutual International policy is not being made for the purpose of concealing funds, assets or wealth with a view to the evasion of any taxes I am obliged to pay. Data Privacy Statement Old Mutual International Business Services Limited and Old Mutual International Isle of Man Limited will process information ( Personal Data ) about me and any other party whose Personal Data has been supplied. The processing of Personal Data will take place in a number of jurisdictions. Personal Data will be processed and may be released to other parties within or outside the Old Mutual Group for the following purposes to: Check against credit reference or other databases to verify information provided for regulatory due diligence purposes and to prevent or detect financial crime including money laundering, terrorist financing, bribery and corruption, or fraud; allow for the provision of services relating to reinsurance, data hosting, online services, payment or reporting of any tax or levy, or any other services provided to policyholders from time to time; Enable an appointed financial adviser, financial adviser representative, or Investment Adviser to assist in provision of services to the policyholder; Compile statistical analysis or market research, where information is not being specific to the individual; Comply with any legal obligation which includes the releasing of Personal Data to regulators, law enforcement authorities or other bodies where it is a legal requirement to do so, including the sharing of information under regulations relating to the U.S. Foreign Account Tax Compliance Act and OECD Common Reporting Standards. Where Personal Data is released to a third party for the provision of services relating to a Policy, the Personal Data will only be used for the purposes for which it is released and will be subject to adequate security and protection. In some circumstances this may involve a transfer of data to a third party outside the European Economic Area (EEA). On receipt of a request to do so and on the payment of a small fee a copy of an individual s Personal Data will be provided to that individual. Any inaccuracies in an individual s Personal Data records will be rectified. Any questions about Data Privacy should be addressed to the Data Protection Officer, Old Mutual International Isle of Man Limited, King Edward Bay House, King Edward Road, Onchan, Isle of Man, British Isles, IM99 1NU. I have read and understood the Data Privacy Statement set out above and will make it available to other individuals whose Personal Data has been provided to Old Mutual International either in this application or within accompanying documentation. Please provide your signature(s) in the following box to confirm that you have read and understood the Declaration by the Settlor(s) and the Data Privacy Statement sections above. Signature of first or sole Settlor Signature of joint Settlor (if any) A copy of the Policy Terms and/or this completed application form are available on request. Date Date continued Page 13 of 15

J Declaration by the Trustee 1. By signing and sealing this application form below, Old Mutual International Trust Company confirms that they have read and understood the terms applying to the contract, and having considered the application completed by the Settlor(s), hereby agree to apply for the International Portfolio Bond Life (ref IPBv2) or International Portfolio Bond Redemption (ref IPBRv2) as indicated in Section A. 2. We confirm that investment into an Old Mutual International - International Portfolio Bond Life or an Old Mutual International - International Portfolio Bond Redemption is within the investment powers available to us as trustees of the trust. 3. We authorise and request Old Mutual International to effect the optional regular loan repayments as detailed in Section I, if applicable to our application, and we confirm that such payments will discharge Old Mutual International from all liabilities and claims arising from those payment. We understand that this authority supersedes any authority previously given. 4. We appoint the financial adviser to act on our behalf in accordance with the Policy Terms. Signature of trustee Date Name of signatory Signature of trustee Date Name of signatory Seal of the trust company K Financial adviser/suitable certifier declaration THIS SECTION MUST BE COMPLETED IN ALL INSTANCES. Declaration by the financial adviser/suitable certifier I declare that: i have verified the contents of the original documents where copies have been enclosed and confirm that they are true copies of the originals. I have taken reasonable steps to make sure that the funding is legitimate and in line with the Settlor s circumstances. to the best of my knowledge and belief, all the information provided in and with this application is true and complete and was obtained from the Settlor(s) who is/are of good standing. I also confirm I will provide further information if required. I have not made any changes to the application form after the trustee applicant(s) (authorised signatories for the corporate trustee, if applicable) have signed it. I confirm that I gave advice concerning this investment to the Settlor(s) in on I confirm that, if applicable, all information provided was received directly from the Settlor(s). Regulatory body authorisation number (if applicable) Regulator name Old Mutual International financial adviser account number Full name of introducer firm Full name of financial adviser/ suitable certifier Signature of financial adviser/ suitable certifier Date Financial adviser stamp Page 14 of 15

Checklist the Settlor(s) The application form Have you completed all the sections which are not optional (lives assured are only required if you are requesting Old Mutual International Trust Company to consider applying for an International Portfolio Bond Life) and signed and dated section J? (3) Even though the applicant for the International Portfolio Bond Life or International Portfolio Bond Redemption will be Old Mutual International Trust Company, you must agree to the declarations in section J by signing and dating in this section. Optional section If you wish to receive regular loan repayments from the Bond, have you completed section I Optional regular loan repayments to the Settlor(s)? (3) Checklist financial adviser Have you completed the financial adviser details on the first page? (3) Have you completed the Old Mutual International Trust Company Adviser application including terms and conditions of business (if you have not previously registered with Old Mutual International Trust Company?) (3) Have you enclosed the following items? A copy of your client s personalised illustration showing the chosen charging structure (3) A completed Old Mutual International Trust Company client agreement and terms of business for Loan Trust, signed and dated by the Settlor(s) (3) A cheque drawn by the Settlor(s), made payable to Old Mutual International Trust Company, or a Telegraphic Transfer* directly to Old Mutual International Trust Company s bank account as detailed in the client agreement. (the client agreement can be found on our website) (3) A completed Old Mutual International Trust Company Loan Trust deed signed by the Settlor(s) (3) Have you included the relevant certified documents.** (3) Please ensure all items are sent to Old Mutual International Trust Company, PO Box 142, King Edward Bay House, King Edward Road, Onchan, Isle of Man IM99 3DJ. * All electronic transfer charges are the responsibility of the Settlor(s), not Old Mutual International/Old Mutual International Trust Company. ** CERTIFYING DOCUMENTS Unless the documents provided are originals, they will all need to be certified by a suitable certifier. A suitable certifier can be any of the following: a regulated introducer, or authorised employee of a regulated introducer, that is based and regulated in a country that is appended to the Isle of Man Money Laundering and Terrorist Financing Code 2013; or a person appointed in writing by Old Mutual International (suitable certifier); or a solicitor, lawyer or advocate; or notary public; or an authorised representative of an embassy or consulate of the country that issued the identification document. When certifying a document, the suitable certifier must include the following wording: I hereby confirm that this document is a true copy of the original. The suitable certifier must also sign and print their name, their position within the company and the date. UK lasting powers of attorney and UK enduring powers of attorney can be certified by the Settlor(s), a solicitor or a notary only. www.oldmutualinternational.com Calls may be monitored and recorded for training purposes and to avoid misunderstandings. Old Mutual International Isle of Man Limited is registered in the Isle of Man under number 24916C. Registered and Head Office: King Edward Bay House, King Edward Road, Onchan, Isle of Man, IM99 1NU, British Isles. Phone: +44 (0)1624 655 555 Fax: +44 (0)1624 611 715. Licensed by the Isle of Man Financial Services Authority. Old Mutual International Isle of Man Limited is a member of the Association of International Life Offices. Old Mutual International is registered in the Isle of Man as a business name of Old Mutual International Isle of Man Limited. Old Mutual International Trust Company Limited is registered in the Isle of Man under number 095926C. Registered and Head Office: PO Box 142, King Edward Bay House, King Edward Road, Onchan, Isle of Man, IM99 3DJ, British Isles. Phone: +44 (0)1624 655 456 Fax: +44 (0)1624 655 930. Licensed by the Isle of Man Financial Services Authority. PDF9105/INT18-0007/January 2018 Page 15 of 15